Apparatus for vessel characterization

ABSTRACT

The invention discloses an apparatus (2), a system (1) and a method (100) for characterization of vessels and for vessel modeling. The cross sectional area (A1) of the vessel is derived from pressure measurements (p1,p2) obtained by an instrument (3) from within the vessel. When multiple cross sectional areas (A1,A2) are derived for multiple reference positions (r1,r2) based on pressure measurements (p1,p2,p3) along the vessel, a representation (20,30) of the vessel can be rendered, without requiring any imaging modality. Furthermore, the effect of the pulsatile blood flow on the elasticity of the vessel walls can be visualized, supporting assessment of a stenosis or an aneurysm formation along the vessel.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present invention is a continuation of U.S. patent application Ser.No. 16/080,243, filed on Aug. 27, 2018, which is the U.S. National Phaseapplication under 35 U.S.C. § 371 of International Application No.PCT/EP2017/054539, filed on Feb. 28, 2017, which claims the beneft ofEuropean Patent Application No. 16158610.2, filed on Mar. 4, 2016. Theseapplications are hereby incorporated by reference herein.

FIELD OF THE INVENTION

The invention relates to an apparatus, system and method forcharacterization of vessels and for vessel modeling.

BACKGROUND OF THE INVENTION

A typical technique for identifying stenotic regions in a blood vesselis using angiography, whereas the functional impact of the stenosis isquantified with the fractional flow reserve (FFR) technique. FFR iscalculated from the ratio of pressures at the distal and proximal endsof the stenosis, measured with a sensor positioned at the tip of a wire.The FFR value is a measure of the severity of the stenosis, and it canbe established whether the stenosis limits blood flow within the vesselto an extent that treatment is required. Common treatment optionsinclude angioplasty, stenting or bypass.

Angiography, a fluoroscopy imaging technique in conjunction withradio-opaque contrast agents, can be used to visualize the vasculatureof a patient. Due to the nature of the technique, only the flow of thecontrast agent can be imaged with fluoroscopy, therefore thecross-sectional shape of the lumen remains unknown, since the vesselwall and the surrounding tissue are not imaged. The weakness of thetechnique is that the cross-sectional shape of the stenosis can only beroughly estimated even by using multiple projections. Furthermore, sucha visual evaluation of the stenotic region may be obstructed by othervessels that overlap the stenosis in the image, as well as by imageartefacts and noise.

U.S. 2015/0119705 A1 describes a method for evaluating a vessel of apatient based on obtaining physiology measurements from a firstinstrument and a second instrument positioned within the vessel of thepatient while the second instrument is moved longitudinally through thevessel from a first position to a second position and the firstinstrument remains stationary within the vessel. The physiologicalmeasurements are based on local blood pressure measurements and thederived values such as FFR are presented on an angiographic image of thevessel. The output image is a visualization of vessels colorizedaccording to the changes in pressure along the vessels, or avisualization of vessels by using a heat map representing FFR values.

SUMMARY OF THE INVENTION

It is an object of the invention to provide an apparatus for simplifyingthe characterization of the vessel. According to the invention, thisobject is realized by an apparatus for characterizing a vessel of aliving being, the apparatus configured to:

receive from an instrument within the vessel a first pressuremeasurement signal at a first measurement location and a second pressuremeasurement signal at a second measurement location;

derive a first cross sectional area for a first reference position ofthe vessel based on the first and second pressure measurement signals.

The apparatus is configured to derive the cross sectional area of thevessel based on two pressure measurements at two distinct locationswithin the vessel, without needing to use information from imagingtechniques such as fluoroscopy in conjunction with radio-opaque contrastagents.

In an embodiment, the apparatus is further configured to receive fromthe instrument within the vessel a third pressure measurement signal ata third measurement location and to derive a second cross sectional areafor a second reference position of the vessel based on the thirdpressure measurement signal and one of the first and second pressuremeasurement signals. The benefit of deriving multiple cross sectionalareas at multiple reference positions along the vessel is that thecondition of the vessel can be evaluated based on the change of thecross sectional diameters at the respective reference positions. In sucha way detection of potential narrowing or widening of the vessel ispossible without using imaging techniques.

In an embodiment, the apparatus is further configured to render arepresentation of the vessel based on the first and second crosssectional areas and the first and second reference positions. Agraphical representation based on the distance between the two referencepositions and the cross sectional areas at the respective locationsimproves the characterization of the vessel by allowing a quick visualinterpretation of the condition of the vessel.

In a further embodiment, the first, second and third pressuremeasurement signals are temporal measurement signals of a pulsatileblood flow within the vessel; the first and second cross sectional areasare derived for subsequent phases of the pulsatile blood flow; and therepresentation of the vessel comprises a sequence of representations ofthe vessel corresponding to the subsequent phases of the pulsatile bloodflow. The pulsatile blood flow is caused by the cardiac heart beatcycle. The graphical representation of the vessel depending on thephases of the pulsatile blood flow allows an improved evaluation ofpotential conditions of the vessel where elasticity of the vesselsegments are influenced by the magnitude of the blood pressure. Suchconditions may be an asymmetric narrowing of the vessel, formation ofaneurysm, etc.

In an embodiment, the apparatus is further configured: to receivemorphological information of the vessel from an imaging unit; to rendera composite representation comprising: a morphological representation ofthe vessel based on the morphological information and the representationof the vessel based on the first and second cross sectional areas andthe first and second reference positions. The representation based onmorphological information received from the imaging unit enriches theinformation available for evaluation of the condition of the vessel,providing the physician with additional information on the orientationof the vessels within the body of the patient.

In a further embodiment, the apparatus is configured to ascertain thefirst measurement location and the second measurement location based oninformation provided by a tracking unit on the position of at least amarker component of the instrument. Tracking the position of componentsof the instrument may be achieved by various techniques ranging fromelectromagnetic tracking to optical shape sensing.

In another aspect of the invention a system for characterizing a vesselof the living being is presented, the system comprising the apparatusaccording to the invention and the instrument configured for providingthe first pressure measurement signal at the first measurement locationand the second pressure measurement signal at the second measurementlocation within the vessel. In an embodiment, the instrument isconfigured to provide a third pressure measurement signal at a thirdmeasurement location. In an embodiment the instrument comprises a first,a second and a third pressure sensor for providing the first, second andthird pressure measurement signals at the first, second and thirdmeasurement locations, respectively. In an alternative embodiment, theinstrument comprises a single pressure measurement sensor, and theinstrument is configured to provide the first, second and third pressuremeasurement signals by subsequent changes of a position of the pressuresensor along the vessel. The subsequent changes of position of thepressure sensor within the vessel may occur by advancing or retrieving(pullback) the instrument within the vessel, or a part of the instrumentcomprising the pressure sensor. The advantage of a single pressuresensor integrated into the instrument is a simpler construction, whilethe advantage of integrating multiple sensors into the instrument isthat during the process of characterization of the vessel there is noneed for changing position of the instrument.

In an embodiment, the system is further configured to receivemorphological information of the vessel from an imaging unit; to rendera composite representation comprising: a morphological representation ofthe vessel based on the morphological information and the representationof the vessel based on the first and second cross sectional areas andthe first and second reference positions. A combination of therepresentation of the vessel based on pressure measurements and therepresentation based on morphological information enriches thepossibilities for evaluation of the vessel condition. An overlay of thetwo representations may be based on visual interpretation by thephysician of particular features (narrowing, widening, bends, etc.) ofthe vessel from the two representations, and it may be enabled for thephysician by a drag and drop technique applied for one of therepresentations. Alternatively, the overlay may be based on automaticregistration by a computer vision algorithm. Once the tworepresentations are registered the measurement locations are also knownwithin the morphological representation. This would replace the need fordevice tracking, while the intravascular pressure data can be displayedat the correct location within the morphological representation.

In a further embodiment, the system comprises the imaging unit, whereinthe system is further configured to ascertain the first measurementlocation and the second measurement location based on detection of atleast a marker component of the instrument by the imaging unit; and toregister the first and second measurement locations with themorphological representation of the vessel. The imaging unit may be aradiological imaging unit, a magnetic resonance imaging unit orultrasound imaging unit. The detection of the instrument or a part ofthe instrument may be enabled by specific markers integrated into theinstrument or by using combination of various materials in thecomposition of the instrument, which are differentiable by therespective imaging modalities. Once the measurement locations areregistered with the morphological representation, the representation ofthe vessel based on pressure measurements can take into account thebends of the vessel.

In yet another aspect of the invention a method of characterizing avessel of a living being is presented, the method comprising:

receiving from an instrument within the vessel a first pressuremeasurement signal at a first measurement location and a second pressuremeasurement signal at a second measurement location; and

deriving a first cross sectional area for a first reference position ofthe vessel based on the first and second pressure measurement signals.

The cross sectional area of the vessel can be derived based on twopressure measurements at two distinct locations within the vessel, whichsimplifies the procedure since for the determination of the crosssectional area of the vessel a radiological imaging unit, such as usedfor fluoroscopy imaging in conjunction with radio-opaque contrastagents, is not necessary.

In a further embodiment, the method comprises:

receiving from the instrument within the vessel a third pressuremeasurement signal at a third measurement location;

deriving a second cross sectional area for a second reference positionof the vessel based on the third pressure measurement signal and one ofthe first and second pressure measurement signals;

rendering a representation of the vessel based on the first and secondcross sectional areas and the first and second reference positions.

By deriving multiple cross sectional areas at multiple referencepositions along the vessel the condition of the vessel can be evaluatedbased on the change of the cross sectional areas at the respectivereference positions. A representation of the vessel with the crosssectional areas at the respective reference positions is an importantvisual support for the physician when assessing presence of stenosisand/or aneurysm along the vessel.

Additional aspects and advantages of the invention will become moreapparent from the following detailed description, which may be bestunderstood with reference to and in conjunction with the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings:

FIG. 1 shows schematically and exemplarily an embodiment of the systemfor characterizing a vessel of a living being, according to theinvention.

FIG. 2 shows schematically and exemplarily an embodiment of theinstrument used for pressure measurement within the vessel.

FIG. 3 shows exemplarily a representation of the pressure measurementsalong a vessel segment.

FIG. 4 shows exemplarily a representation of the cross sectional areasof the vessel ascertained based on the pressure measurements along thevessel segment.

FIG. 5 shows a three-dimensional representation of the vessel modelbased on the cross sectional areas along the vessel segment.

FIG. 6 shows a two-dimensional projection of the three-dimensionalvessel model.

FIG. 7 shows a three-dimensional representation of the vessel model bytaking into account the shape of the position tracked instrument.

FIG. 8 shows the two-dimensional projection of the three-dimensionalvessel model by taking into account the shape of the position trackedinstrument.

FIG. 9 shows exemplarily a pulsatile blood pressure measurement.

FIG. 10 shows schematically and exemplarily the morphology of abranching vessel obtained by angiography.

FIG. 11 shows schematically and exemplarily a three-dimensional vesselmodel generated by using pressure measurements during pull-back of theinstrument.

FIG. 12 shows schematically and exemplarily a two-dimensional projectionof the vessel model superimposed onto the morphological representationof the branching vessel.

FIG. 13 shows schematically a method of characterizing a vessel of aliving being.

DETAILED DESCRIPTION OF EMBODIMENTS

In FIG. 1 an embodiment of the system 1 for characterization of a vesselof a living being 4 is presented, wherein the living being may be aperson or an animal. The system 1 comprises an apparatus 2 and aninstrument 3, wherein the instrument is configured to provide pressuremeasurement signals from within a vessel of a portion 41 of thecirculatory system of the patient 4, and the apparatus 2 is configuredto ascertain characteristics of the vessel based on the pressuremeasurements. The apparatus 2 comprises a display 21 for rendering thecharacteristics of the vessel. Alternatively, the apparatus may beconfigured to provide signals to an external display on which thedesignated characteristics are presented to the physicians.

In an embodiment, the system comprises an imaging unit 6 for acquiringtwo-dimensional or three-dimensional morphological information of thevessel structure of interest upon injection of a contrast agent bolusinto the targeted vasculature. The injection of the contrast agent bolusinto the targeted vasculature is performed either with the instrument 3or with a different medical instrument. Two-dimensional orthree-dimensional morphology of the vasculature can be obtained byvarious well established techniques such as: radiological angiographyincluding computed tomography angiography (RA), magnetic resonanceangiography (MRA) or ultrasound imaging (UI). For the respective imagingmodalities contrast agents are available, for instance radiologicalcontrast agent for RA, a gadolinium-based substance for MRA, echogeniccontrast agent comprising microbubbles for extracorporal orintracorporal UI.

An exemplarily embodiment of the medical instrument 3 used for pressuremeasurement within the vessel is a guiding catheter-guidewire assembly,shown in FIG. 2. The guiding catheter 31 is formed by a hollow handgripand an elongated flexible tubular shaft comprising an inner lumen, andit is configured to movably receive the guidewire 32 formed by aflexible shaft. A pressure sensor 311 is integrated into the distalportion of the guiding catheter 31 for measurement of a blood pressure.The guidewire 32 also comprises at least a pressure sensor 321integrated into its distal portion, for measurement of blood pressure atmultiple locations along the blood vessel by using a pullback motion ofthe guidewire with respect to the blood vessel. Typical example for suchguidewire is the Verrata® pressurewire, manufactured by VolcanoCorporation.

In an embodiment, the guidewire 32 may comprise multiple sensors321,322,323, distributed spatially along its distal portion, such thatmultiple pressure measurements along the vessel can be acquired in astationary position of the guidewire with respect to the blood vessel,without the classical guidewire pullback being required.

In an alternative embodiment, the instrument 3 may be formed as acatheter comprising a handgrip, an elongated flexible tubular shaft withan inner lumen configured to movably receive a telescopically extensibleflexible shaft reaching distal to the tubular elongated shaft. Theconnection of the instrument 3 to the apparatus 2 is realized either bya connector 33 or a wireless connection. A pressure sensor 311 isintegrated into the distal portion of the elongated tubular shaft, whileat least one pressure sensor 321 is integrated into the distal portionof the telescopically extendable part of the medical instrument.

In yet another embodiment the instrument 3 may comprise only theguidewire 32 with at least one integrated pressure sensor 321 into itsdistal region.

The pressure sensors may employ one of the various techniques for bloodpressure measurements, for instance the change of piezoresistiveproperty upon pressure, fluidic transduction of a deflection of adiaphragm to a mechanical or an electrical signal, and capacitivereadout of a suspended membrane over a substrate.

FIG. 3 shows exemplarily a representation of the pressure measurement palong a vessel segment s. The instrument within the vessel provides afirst pressure measurement signal p₁ at a first measurement location l₁in the vessel and a second pressure measurement signal p₂ at a secondmeasurement location l₂. The pressure drop for the segment s₁ defined bythe two measurement locations is Δp(s₁)=p₂-p₁. Using a linear orderapproximation the volumetric flow Q along a tubular structure is Q=Δp/R,where R is the resistance of the vessel to flow. Higher order terms torelate Δp and Q could be used as well. The resistance R is a function ofthe cross sectional area A of the vessel lumen. This relation can bedetermined by a numerical fluid dynamics model, e.g. in a simple modelbased on the Hagen-Poiseuille equation the resistance R=8μs₁/πr⁴, wheres₁ is the distance between measurement locations l₁and l₂, r is theradius of the vessel lumen, and μ is the dynamic viscosity of blood.Alternatively, a more complex fluid dynamics model may be used.

The corresponding inverse function can then be used to calculate thecross sectional area of the vessel lumen from a known resistance. Byusing a constant volumetric blood flow value and the pressure drop Δp(s)for various segments of the vessel defined by multiple pressuremeasurement locations, the cross sectional area A(s) can be calculatedat any position along the vessel segment with the relationship:

A(s)=A(R(s)), where R(s)=Δp(s)/Q.

The flow rate can be obtained by an additional intravascularmeasurement, or derived in any other suitable way. A volumetric flowrate as well as other related quantities e.g. flow velocity or averagepeak flow velocity can be used.

If the relation A(R(s)) is a homomorphism, the relative variationA(R(s₁))/A(R(s₂)) can be calculated without needing the flow rate asinput.

The measurement locations chosen in FIG. 3 are distant, in order tosupport the exemplary elucidation of the invention, however themeasurement locations can be very close to each other, which can beachieved either by taking pressure measurements with the pressure wirehaving a slow pullback, or by making small incremental steps during thepullback motion. The cross sectional area A₁ is derived for the segments₁ defined by the pressure measurement locations l₁ and l₂. Whenmultiple pressure measurements p₁ to p₅ are provided at multiplemeasurement locations l₁ to l₅, like for example in FIG. 3, then thereference positions r₁ to r₄ can be defined along the respective vesselsegments s₁ to s₄, and the cross sectional areas A₁ to A₄ can beassigned to the respective reference positions. The points (r₁,A₁) to(r₄,A₄) can be connected by using an appropriate interpolation functionfor providing a smooth transition of the cross sectional areas betweenthe reference positions, resulting in a representation illustrated inFIG. 4. The reference positions are located along the respective vesselsegments, and they may be chosen as the middle of the segments, one ofthe measurement locations defining the respective segments, or they maybe determined by using a function depending on the derived crosssectional area for the respective segment and that of the adjacentsegment, for instance by using a weighted average. An intuitiveillustration of the cross sectional areas in function of the respectivereference positions along the blood vessel is a three-dimensionalgraphical representation 20 shown in figure FIG. 5. In an embodimentshown in FIG. 6, a two-dimensional projection 30 of thethree-dimensional vessel model 20 is presented to the physician on thedisplay 21. A further alternative representation may comprise thediameters at the respective reference positions, which can be derivedfrom the respective cross sectional areas. The cross sectional areasand/or diameters can be derived for the entire length of the bloodvessel defined by the locations of the first and last pressuremeasurements, based on the interpolation function.

In a further embodiment, the instrument is configured to provide bloodflow measurement besides the pressure measurements, hence the volumetricblood flow is calculated based on the blood flow measurement, which isthen used in the calculation of the cross sectional areas A(s) and thediameters along the vessel.

The system 1 in FIG. 1 may further comprise a tracking unit 72 forreceiving temporal information about the location of the instrument 3within the vasculature of the person 4. Spatial position tracking of theinstrument may be based on one of an electromagnetic, an optical, anultrasound, an electrical impedance and a radiological principle.Electromagnetic tracking of instruments is based on detection of anexternal electromagnetic field by electromagnetic sensors integratedinto the instrument. The electromagnetic sensors, functioning as markers325 in the electromagnetic field, are integrated into the distal portionof the instrument 3, for instance in the guiding catheter 31 and theguidewire 32, located at predetermined relative positions with respectto the pressure sensors 311 and 321, as shown in FIG. 2. Theelectromagnetic field generator 71 may be removably attached to eitherthe support means 5 of the person 4 or to the imaging unit 6. Multipleelectromagnetic sensors integrated into the instrument 3 allowsimultaneous localization of multiple points along the instrument 3,based on which the shape of a segment of the instrument 3 can bereconstructed by connecting the localized points.

In an alternative embodiment, the tracking of the temporal location ofthe instrument is derived from laser radiation. For optical tracking,the instrument comprises multiple optical fibers or a multi-core opticalfiber extending from distal end to a proximal portion of the instrument3, typically the handgrip, where optical connection to the tracking unit72 is facilitated. The tracking unit 72 comprises a laser radiationgenerator configured to transmit laser radiation into at least anoptical fiber integrated within the instrument, and an optical detectorconfigured to receive reflections from within the at least one opticalfiber. The shape of the at least one optical fiber, hence that of theinstrument 3 is derived by processing optical reflection signals fromwithin the optical fibers, received by a detector. The reflections ofthe laser radiation from within the at least one optical fiber areindicative of local strains to which the instrument 3 is exposed intortuous vessel branches. Shape determination of a medical instrumentbased on optical shape sensing is described in details in WO 2008131303A2. Optical shape sensing makes possible the localization of any pointsalong the at least one optical fiber integrated into the instrument 3for all instances.

In an alternative embodiment the location tracking technique of theinstrument is based on electrical impedance measurement. Electricalsignals are sent into the patient by multiple electrically conductivepatches distributed onto the body of the person 4. The distal portion ofthe trackable instrument 3 comprises spatially distributed electricallyconductive electrodes, functioning as markers 325 for their relativepositions with respect to the electrically conductive patches. Theelectrical impedances derived from the received electrical signals areindicative of the locations of the conductive electrodes in the regionof interest comprising the target vasculature.

In yet a further embodiment the location of the instrument 3 is trackedby using the imaging unit. The instrument comprises specific markers 325visible with the imaging modality used in the procedure. In case ofradiological imaging, the instrument 3 comprises radiological markersalong the distal portion of the instrument 3 at predetermined locationswith respect to the pressure sensors 311 and 321, whereas for ultrasoundimaging the instrument 3 comprises ultrasound sensors as markers 325,distributed spatially along the instrument. Upon excitation of theexternal ultrasound imaging unit with an electric signal, the generatedultrasound signal is transmitted into the body of the person 4 and aportion of the ultrasound signal is received by the ultrasound sensorsintegrated into the instrument 3. The time of flight of the ultrasoundsignals is indicative of the positions of the ultrasound sensorsintegrated into the instrument 3 with respect to the external ultrasoundimaging unit, and by processing the signals the shape of the distalportion of the instrument comprising the ultrasound sensors can bereconstructed.

With the reconstruction of the shape of the instrument 3 based on thetracked locations of markers 325 spatially distributed along the distalportion, the three-dimensional graphical representation 20 of the bloodvessel can be improved by accounting for the bends encountered by theinstrument along the vessel segment of interest, as illustrated in FIG.7. The bends of the vessel segment may also be represented in thetwo-dimensional projection 30, as shown in FIG. 8.

The blood flow in the vessel has a pulsatile nature, illustrated in FIG.9, and the cross sectional area of the vessel can be derived based onthe pressure measurement signals averaged over a single cardiac cycle orover multiple cardiac cycles for the respective measurement locations.In an alternative embodiment, the cross sectional areas of the vesselare derived for subsequent phases I to VI of the pulsatile blood flow,and the representation of the vessel comprises a sequence ofrepresentations of the vessel corresponding to the subsequent phases ofthe pulsatile blood flow. The vessel may be displayed to the physicianas a succession of frames of graphical representations rendered for theconsecutive phases I to VI, or alternatively the physician may selectparticular phases of interest of the cardiac cycle for evaluation ofpotential conditions of the vessel where elasticity of the vesselsegments may play a role, for instance in the evaluation of anasymmetric narrowing of the vessel and presence of an aneurysm.

In an embodiment, the imaging unit 6 provides two-dimensional orthree-dimensional morphological information of the vessel structure ofinterest upon injection of a contrast agent bolus in the targetedvasculature, and the morphology 40 of the vessel is rendered on thedisplay 21, as shown in FIG. 10. The shape of the instrument may bereconstructed and visualized as an overlay of the instrument 3 on thevessel morphology 40. In FIG. 11 the instrument 3 is pulled back from aposition 42 of its distal end to a position 43, while pressuremeasurement signals are acquired along the pullback length with thepressure sensor integrated into the distal region of the instrument. Theposition of the distal tip is continuously visualized by the imagingunit, therefore the trajectory of the tip can be reconstructed.

The three-dimensional graphical representation 20 of the vessel modelcan be obtained by combination of the reconstructed trajectory of thedistal tip of the instrument and the derived cross sectional areas ofthe vessel based on the pressure measurements along the pullbackdistance. The vessel model is presented separate from the vesselmorphology to the physician, and the physician may use a user interfacesuch as a touch screen or pointer means to superimpose thethree-dimensional vessel model 20 onto the vessel morphology 40. Afurther alternative is the registration of the location information ofthe distal end or a portion of the distal region of the instrumentcomprising markers 325 during the pullback motion to the two-dimensionalangiographic projection or to the three-dimensional angiographicrepresentation. The two-dimensional projection 30 or thethree-dimensional representation 20 of the vessel model can be graduallysuperimposed onto the vessel morphology 40 as the pressure measurementsare processed and the cross sectional areas of the vessel are derivedfor the respective positions of the distal tip of the instrument, asshown in FIG. 12. With shape reconstruction of the instrument 3 based onoptical shape sensing and by using multiple pressure sensors spatiallydistributed along the distal portion of the instrument, thetwo-dimensional projection 30 or the three-dimensional representation 20of the vessel can be superimposed onto the vessel morphology 40 whilethe instrument is stationary with respect to the vessel, hence withoutrequiring a pullback of the instrument.

In FIG. 13 a method 100 of characterizing a vessel of a living being ispresented, comprising: receiving 101 from an instrument 3 within thevessel a first pressure measurement signal p₁ at a first measurementlocation l₁ and a second pressure measurement signal p₂ at a secondmeasurement location l₂; and deriving 102 a first cross sectional areaA₁ for a first reference position r₁ of the vessel based on the firstand second pressure measurement signals p₁,p₂. In an embodiment themethod further comprises: receiving 103 from the instrument within thevessel a third pressure measurement signal p₃ at a third measurementlocation l₃; deriving 104 a second cross sectional area A₂ for a secondreference position r₂ of the vessel based on the third pressuremeasurement signal p₃ and one of the first and second pressuremeasurement signals p₁,p₂; and rendering 105 a representation of thevessel based on the first and second cross sectional areas A₁,A₂ and thefirst and second reference positions r₁,r₂.

In an embodiment the method may further comprise: receiving 106morphological information of the vessel from an imaging unit 6;rendering 107 a morphological representation 40 of the vessel based onthe morphological information; and composing 108 the morphologicalrepresentation 40 of the vessel with either the three-dimensional vesselmodel 20 or the two-dimensional projection 30 of the vessel modelrendered based on the first and second cross sectional areas A₁,A₂, andthe first and second reference positions r₁,r₂.

Although the cross sectional area of the vessel is derived from thepressure measurement signals in the exemplary description, it can beunderstood and effected by those skilled in the art in practicing theclaimed invention that a diameter, a radius or a perimeter can bederived from the cross sectional area of the vessel by simplemathematical formulas, therefore the cross sectional area of the vesselin the claimed invention should not be construed as limiting the scopeof the invention.

A single unit or device may fulfill the functions of several itemsrecited in the claims. The mere fact that certain measures are recitedin mutually different dependent claims does not indicate that acombination of these measures cannot be used to advantage.

In the claims, the word “comprising” does not exclude other elements orsteps, and the indefinite article “a” or “an” does not exclude aplurality.

Any reference signs in the claims should not be construed as limitingthe scope.

1. An apparatus for assessing a vessel of a patient, the apparatuscomprising: a processor configured to: receive, from an instrumentpositioned within the vessel, a plurality of pressure measurementscorresponding to a plurality of locations within the vessel; derive afirst cross-sectional area for a first position of the vessel based on afirst set of pressure measurements of the plurality of pressuremeasurements; derive a second cross-sectional area for a differentsecond position of the vessel based on a second set of pressuremeasurements of the plurality of pressure measurements; generate arepresentation of the vessel based on the first cross-sectional area andthe second cross-sectional area; and output the representation of thevessel to a display in communication with the processor.
 2. Theapparatus of claim 1, wherein the processor is further configured to:receive morphological information of the vessel from an imaging unit;generate a composite representation comprising: a morphologicalrepresentation of the vessel based on the morphological information; andthe representation of the vessel based on the first and secondcross-sectional areas and the first and second positions.
 3. Theapparatus of claim 1, wherein the processor is configured to derive thefirst and second cross-sectional areas for subsequent phases of apulsatile blood flow in the vessel.
 4. The apparatus of claim 3, whereinthe representation of the vessel comprises a sequence of representationsof the vessel corresponding to the subsequent phases of the pulsatileblood flow.
 5. The apparatus of claim 1, wherein the representationcomprises a two-dimensional, longitudinal representation of the vessel.6. The apparatus of claim 1, wherein the representation comprises athree-dimensional representation of the vessel.
 7. The apparatus ofclaim 1, wherein: the first set of pressure measurements correspond to afirst set of locations of the plurality of locations, and the second setof pressure measurements correspond to a different second set oflocations of the plurality of locations.
 8. The apparatus of claim 7,wherein: the first set of pressure measurements comprises a firstpressure measurement corresponding to a first location and a secondpressure measurement corresponding to a second location of the vessel,and the second set of pressure measurements comprises a third pressuremeasurement corresponding to a third location of the vessel and one ofthe first pressure measurement or the second pressure measurement. 9.The apparatus of claim 8, wherein the processor is further configured toascertain the first, second and third locations based on a position ofat least one marker component of the instrument.
 10. The apparatus ofclaim 9, wherein the processor is further configured to: identify a bendin the instrument based on the position of the at least one markercomponent of the instrument; and generate the representation such thatthe representation visualizes the bend.
 11. A system for characterizinga vessel of a living being, comprising: the apparatus of claim 6; andthe instrument comprising at least one pressure sensor configured forproviding the first and second sets of pressure measurements at theplurality of locations within the vessel.
 12. The system according toclaim 11, wherein: the at least one pressure sensor provides the firstpressure measurement at the first location, the instrument comprises asecond and a third pressure sensor for providing the second and thirdpressure measurements at the second and third locations, respectively.13. The system according to claim 11, wherein: the instrument isconfigured to provide the first, second and third pressure measurementsby subsequent changes of a position of the at least one pressure sensoralong the vessel.
 14. The system according to claim 11, wherein theinstrument comprises at least one of a pressure-sensing catheter or apressure-sensing guidewire.